Institute of Traditional Medicine Services (Bhutan)

The Institute of Traditional Medicine Services (ITMS), previously known as the National Institute of Traditional Medicine, is the principal Bhutanese institution for the practice, training and pharmaceutical production of gSo-ba Rig-pa or Sowa Rigpa, the traditional Tibetan-Himalayan medical system practised in Bhutan. The institute is based in Thimphu, with a hospital, pharmaceutical laboratory and herbarium at Kawang Jangsa.^[1]

Sowa Rigpa is one of two recognised systems of medicine offered through Bhutan's national health service, the other being modern allopathic medicine. Traditional medicine units operate in all twenty dzongkhags, each staffed by at least one drungtsho (traditional physician) and one menpa (traditional medical assistant). Training of drungtshos and menpas is now conducted by the Faculty of Traditional Medicine of Khesar Gyalpo University of Medical Sciences of Bhutan, which works in close partnership with ITMS.

The institute treats more than 40,000 patients each year at its Thimphu hospital and produces a wide range of traditional formulations from Himalayan medicinal plants, minerals and animal products at its in-house pharmaceutical laboratory.

Origins and royal command

The formal integration of traditional medicine into Bhutan's state health service dates from 1967, when the Third King, Jigme Dorji Wangchuck, directed the Department of Health to establish a state-supported traditional medicine service. An Indigenous Dispensary was opened at Dechencholing, Thimphu, in 1968, staffed by a small group of senior practitioners drawn from the country's monastic and lay traditions.^[2]

In 1978 the Fourth King, Jigme Singye Wangchuck, issued a royal command for the establishment of a formal Drungtsho training programme to address the shortage of qualified practitioners. The dispensary at Dechencholing was upgraded the following year to the Indigenous Hospital and relocated to its current site at Kawang Jangsa.

Institutional development

The Indigenous Hospital was renamed the National Institute of Traditional Medicine in 1988 and gradually expanded its activities to include outpatient services, pharmaceutical production and applied research. The institute was upgraded to the Institute of Traditional Medicine Services in 1998, reflecting the growth in patient numbers and the elaboration of its training and research mandates.^[3]

By the end of 2001 traditional medicine units were in place in all 20 dzongkhags. Each unit forms part of the dzongkhag hospital or basic health unit and offers free outpatient consultation and traditional formulations on the same terms as modern medical services.

Sowa Rigpa: doctrinal background

Bhutanese Sowa Rigpa derives from the same canonical sources as Tibetan Sowa Rigpa, principally the Gyud Zhi (Four Tantras), traditionally attributed to the eighth-century physician Yuthok Yonten Gonpo and codified in its current form in the seventeenth century. Bhutanese practice has nonetheless developed distinctive features, including the use of medicinal plants endemic to the eastern Himalaya and the integration of practices drawn from local Buddhist traditions. The body of Sowa Rigpa medicines used at ITMS includes preparations made from minerals, precious metals, gems, animal parts and several hundred plant species, many collected from high-altitude habitats in northern Bhutan.^[4]

Training: the Faculty of Traditional Medicine

For most of its history ITMS conducted drungtsho and menpa training in-house. In 2013 these training functions were transferred to the newly established Faculty of Traditional Medicine of Khesar Gyalpo University of Medical Sciences of Bhutan, which now offers a five-year Bachelor of Sowa Rigpa Medicine for drungtshos and a three-year Diploma in Traditional Medicine for menpas. The Faculty operates from a campus adjacent to the ITMS hospital and works in close clinical partnership with the institute. Programmes are recognised by the Bhutan Medical and Health Council and the Royal Civil Service Commission.^[5]

Hospital and pharmaceutical production

The ITMS hospital at Kawang Jangsa offers outpatient consultation, traditional therapies including herbal compresses, moxibustion, golden-needle therapy, blood-letting and gold and copper acupuncture, and inpatient care for selected conditions. The institute's pharmaceutical laboratory produces standardised formulations including pills, decoctions, ointments and incenses for use at the Thimphu hospital and at traditional medicine units across the country.

The institute also maintains a herbarium and a research unit which document the medicinal flora of Bhutan, support sustainable harvesting protocols, and contribute to the international academic literature on Himalayan ethnobotany and ethnopharmacology.^[6]

Practical information

Location: Kawang Jangsa, Thimphu, Bhutan
Established: 1968 (Indigenous Dispensary at Dechencholing); reorganised as Institute of Traditional Medicine Services in 1998
Affiliated training body: Faculty of Traditional Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan
Services: Outpatient consultation, traditional therapies, pharmaceutical production, in-service training and research